Apply for Counseling/Coaching

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• After submission, check your email for further instructions.

• I'd love to connect personally, but high demand makes that tough, so automated emails will have to do.

• Read them carefully, use the resources, and follow instructions to ensure a good fit.

• The final email will tell you exactly how to join the waitlist. Don't miss it!

Reminder: this is NOT intake paperwork to become a client.

Email *

First Name *

Last Name *

Who can we thank for the referral? (please be specific) *

What is your age? *

What is your gender? *

Male

Female

Prefer not to say

Marital Status *

How many children do you have? *

Do to want to work on marriage dynamics? *

Yes

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